TOBIA, GIUDITTA, ESTER (Libri storici) Il Libro di Tobia Il libro di Tobia è una fantasiosa storia familiare che vuole dimostrare la cura che Dio haLa storia si inquadra nel periodo del 'esilio babilonese e ha come protagonisti Tobi,diventato accidentalmente cieco, e suo figlio Tobia. Tobi prega di poter morire, mentre nel o stesso tempo una giovane di nome Sara prega diessere liberata
Devesteynde.nlNew hope for patients with psoriasis from planar shock wave treatment An estimated 25 million people around the world are affected by psoriasis. In Germany alone,
between two and three million people (2-3% of the population) suffer from this unpleasant skin
Fig. 2: The Duolith SD1 planar applicator There are various therapeutic approaches for alleviating symptoms, including topical treatments with salicylic acid, urea, polidocanol, tar, dithranol, cortisone and Vitamin D and A derivatives. Systemic treatments include methotrexate, corticosteroids, immunosuppressants, fumarates and biologicals. In addition to various alternative medical treatments, such as acupuncture and homeopathy, bath, light and climate therapies also represent promising treatment approaches. In addition, the precise application of a special laser light to the affected areas is now considered a standard treatment.
The first attempt to use planar shock waves to treat a patient who had been suffering from psoriasis vulgaris for many years was undertaken in October 2006.
Shock waves are rapid sound waves which trigger a biological response in treated tissue and can thus give rise to a range of effects. Details of the mode Fig. 1: The Duolith SD1 shock wave source from of action of shock waves on different cell types have not yet been fully elucidated. What is considered certain is that growth factor formation and an increase in perfusion occurs, leading in the Treatment of psoriasis is, however, considered difficult. Because the disease is triggered by a development of new, healthy tissue in the area genetic defect, no causal treatment is possible. Focused shock waves have been used with great problematic, as they did not respond to either success in the treatment of orthopaedic problems such as tendinosis calcarea, lateral and medial humeral We used planar shock waves generated using the pseudoarthrosis for around 15 years. Extracorporeal Duolith SD1 device manufactured by the Swiss shock wave therapy (ESWT) was originally company Storz Medical AG (Fig. 1). The high developed for use in urology, where it has been energy sound waves were applied to the margins of used to destroy kidney stones non-invasively for the psoriatic plaques using a mobile applicator (Fig. 2). Sterile ultrasound gel was first applied to the psoriatic plaques on the lower leg, which were then Recently, extracorporeal (usually planar) shock covered with a sterile film, to which a generous waves have also begun to be used in dermatology. amount of additional ultrasound gel was then Poorly healing wounds, such as leg ulcers, burns or applied. The margins of the psoriatic plaques were diabetic leg ulcers, are being treated today with then treated with a dosage of 0.22 mJ/mm and 200 pulses per cm² at a shock frequency of 4 Hz.
As a result of these insights, a first-ever attempt to The patient was treated using this therapy regime a use planar shock waves for treating psoriasis was total of four times. The interval between treatment sessions was 2 weeks. No topical or systemic treatment was administered in tandem with this The treatment was performed on a 55-year-old female patient who had been suffering from psoriasis for 30 years. She did not suffer from psoriatic arthritis. The skin plaques on the lower legs Fig. 5: 2 weeks after the 4th treatment Narrowing of the margins, less intensive reddening To evaluate treatment outcome, photos of the psoriatic plaques were made prior to the first treatment session and after the final (5th) treatment session.
Evaluation of the photographs shows visible improvement to the psoriasis after just 4 treatments, i.e. within 8 weeks. Scale formation, the core growth phenomenon, is significantly less pronounced and the margins of the lesions are no longer so sharply delineated. Signs of healing are clearly visible.
Fig. 6: Psoriasis also present on the other leg. The patient failed to present, as arranged, for Treatment with extracorporeal shock wave therapy follow-up after completion of the treatment. In (ESWT) clearly offers new hope for patients with June 2008, 1.5 years after the final ESWT treatment, the patient returned to the practice because of an orthopaedic problem. She stated is that the shock waves can be applied directly to that the lesions had healed completely 3 months the affected area. In general, the treatment enjoys after the final treatment and that no new plaques good patient acceptance, as, when used correctly had appeared on the treated lower leg since the (sterile cover, energy not greater than 0.22 treatment, a period of more than a year. No new mJ/mm²), no side effects should occur and the use episode had occurred. After 1.5 years, the plaques of planar shock waves of up to 0.22 mJ/mm² is have healed completely, with no visible reddening almost painless. The success of the treatment is or scale formation. Skin quality appears normal. visible after just a few (3-6) sessions. ESWT The psoriatic plaque on the other, untreated lower treatment can be repeated after a treatment-free leg (Fig. 6) is still present. This plaque was very period of 3 months. The very good long-term small and the patient was not bothered by it, but results after 1.5 years give patients with psoriasis nonetheless the psoriasis was still clearly visible.
hope for an alternative to topical treatments and for a treatment to supplement systemic treatment methods.
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A further observational study with more patients is planned to confirm this result.
Orthopädische PraxisR. RädelHaupt Str. 30944649 HerneGermany Tel: +49 (0)2325 988236Fax: +49 (0)2325 988237 Translation of: „Neue Hoffnung für Patienten mit Psoriasis durch die Behandlung mit planaren Stosswellen“R. Rädel Published in Ästhetische Dermatologie 4, 2008
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